INSIGHTS INTO MULTIPLE MYELOMAOctober 2019

HOW TO NAVIGATE THIS REPORT

Click to move to topic of interest or

ARS supporting data

Click to return to previous slide

2

CONTENTS

Topic Slide

Study Objectives

Report Snapshot

Participant Demographics

Key Insights

ARS Data – Baseline

ARS Data – First-Line Therapy

ARS Data – First Relapse

ARS Data – Subsequent Relapse

Advisor Takeaways

3

STUDY OBJECTIVES

To gain advisors’ perspectives on the following

> Current treatment practices regarding frontline therapy of multiple myeloma (MM)

> The evolving role of MRD testing in MM

> Current treatment practices in later lines of therapy and attitudes toward recently introduced agents

4

REPORT SNAPSHOT

> A moderated roundtable discussion focusing on treatment of MM was held on October 26, 2019, in Seattle, WA

> Disease state and data presentations were developed in conjunction with a medical expert from University of Washington/Fred Hutch/Seattle Cancer Care Alliance

> The group of advisors comprised 9 community oncologists

> Insights on the following therapies were obtained: bortezomib, carfilzomib, ixazomib, elotuzumab, daratumumab, lenalidomide, pomalidomide, thalidomide, melphalan,

cyclophosphamide, bendamustine, panobinostat, selinexor, isatuximab

> Data collection was accomplished through use of audience response system questioning and moderated discussion

5

Participant Demographics

PARTICIPANT DEMOGRAPHICS

7

What percentage of the patients with

hematologic malignancies that you see have

multiple myeloma? (N = 8)

How many unique patients with multiple

myeloma have you treated in the past

year? (N = 9)

For the majority of advisors, multiple myeloma accounts for over 15% of their patients with hematologic

malignancies. A third of the advisors see 16–20 patients with multiple myeloma in a year, with another third

seeing more than 21 patients.

25%

38%

38%

0%

1%–5%

6%–15%

16%–20%

≥21%

11%

34%

33%

0

1–5

6–10

11–15

16–20

≥21

11%

11%

Key Insights

TOPLINE TAKEAWAYS

RVd followed by autologous transplant continues to be the standard for transplant-eligible patients. Some advisors are beginning to use KRd in

higher-risk patients as well as patients with less than stellar response to RVd. In transplant-ineligible patients, RVd and RVd-lite (for elderly

patients) continue to be the standard. A few advisors are beginning to adopt Dara-RVd, though many others are shying away from using

daratumumab in the frontline setting due to factors like cost, chair time, and daratumumab’s proven efficacy in R/R settings. However, advisors

would consider using daratumumab in the frontline setting if they see strong data suggesting that 4-drug combinations are superior to 3-drug

combinations.

First-Line Therapy

There is no standard of care or a consensus among the advisors in the setting of first relapse, but prior treatment, physician preference, as well

as cost of the treatment appear to heavily influence treatment selection. Patients are being treated with a PI and IMiD (different from the first

line or the same, depending on patient’s sensitivity to the drug) either in combination with daratumumab or carfilzomib. Some advisors have

started trying elotuzumab in combination with PI and IMiDs. There is some interest in using venetoclax and isatuximab in the first-relapse

setting as well.

First Relapse

Daratumumab is currently the preferred treatment in the setting of multiple relapses. But as daratumumab continues to move up to earlier lines

of treatment, advisors have begun selecting drugs like elotuzumab, selinexor, venetoclax, or bendamustine on the basis of more-recent data.

There is also some interest in isatuximab, provided that more data on its efficacy after usage of daratumumab become available. Despite the

interest in newer drugs, most advisors are unfamiliar and uncomfortable with the toxicities of these agents, and want to be cautious until more

data on their safety are available.

Subsequent Relapse

9

FIRST-LINE THERAPY

Topic Data and Insights

Transplant

eligible

• The majority of advisors (78%) do not believe that early vs delayed transplant impacts PFS

– In an example case of a patient achieving VGPR on RVd induction, 67% of advisors would choose to refer to

transplant, 22% would delay transplant, and 11% would just continue with full-dose RVd

• 100% of advisors believe that 3-drug induction regimens are better than 2-drug regimens for transplant-eligible patients,

with 89% preferring RVd and 11% preferring KRd

• At least 2 advisors indicated a preference for KRd induction

– For a 68-year-old patient progressing from smoldering myeloma and developing progressive anemia with 50%

plasma cells, 78% of advisors would treat with RVd, while 22% would give KRd

• A little over half of the advisors (56%) believe that 4-drug regimens are superior to 3-drug regimens

• While there is a lot of interest in Dara-RVd or Dara-KRd in transplant-eligible patients, advisors indicated they would need

to see convincing data to support this treatment approach, particularly given the cost of these combinations and the

proven efficacy of Dara in a relapsed/refractory setting

Transplant

ineligible

• RVd is the treatment preferred by 67% of advisors for transplant-ineligible patients

– One advisor prefers Rd, and 2 advisors would choose alternate regimens not listed

– In an example patient case of a newly diagnosed 82-year-old patient, 44% of advisors chose RVd, 1 advisor each

chose Rd, VCd, and Dara-Rd, and 1 other advisor chose an alternate regimen not listed

• 89% of the advisors do not include melphalan in their induction treatment for older patients

Maintenance

therapy

• 100% of advisors feel that maintenance therapy should be given to all patients

• Lenalidomide is the most-preferred maintenance regimen for patients with high-risk genetics (56%), with 22% of advisors

choosing to give Rd, and 1 advisor each choosing RV and bortezomib (+/– Dex)

• A majority (88%) of the advisors are not testing for MRD or using these data to drive their treatment selection

10

FIRST-LINE TREATMENT QUOTES

[On using Ixazomib-Rev-Dex in the frontline

setting] “I have personally found reimbursement for

that to be really difficult.”

[On using daratumumab in the frontline setting]

“That's a lifestyle change [intravenous infusion]. But

the subcutaneous version could change [my]

perception.”

[On the ideal patient for upfront (potential)

daratumumab-RVd regimen in the future] “I could

use it in somebody who is young and fit, with the

Dara-RVd upfront with the hope to minimize

transplantation in the future.”

[On using daratumumab in the frontline setting]

“If you're going to increase the cost of the induction

regimen so much, I really want to know that you're

hopefully able to demonstrate an overall survival

benefit or some relapse-free survival benefit.”

11

FIRST-RELAPSE THERAPY

Topic Data and Insights

Advantages

and

disadvantages

• 67% of advisors feel the CR rate associated with carfilzomib is its most significant advantage, while IV

administration was identified as the biggest disadvantage (56%)

• Mechanism of action was identified as the biggest benefit of elotuzumab, followed by its synergy with

lenalidomide, while its lack of single-agent activity is its biggest disadvantage

• The novel mode of action as well as the efficacy of daratumumab are considered its biggest advantages,

while infusion reactions and schedule of administration are the biggest disadvantages

• 78% of advisors said that ixazomib being an oral agent is its most significant advantage, while difficulty in

obtaining reimbursement and similarity to bortezomib are the biggest disadvantages

Patient case • Prior treatment was identified as the most important factor influencing the selection of salvage treatment

(100% of the advisors)

• As commonly observed, there is no consensus among advisors regarding treatment selection in the

setting of first relapse, reflecting the large variety of options available

• In an example of a 76-year-old patient who develops progressive disease 4 years after achieving a CR

following transplant and not receiving maintenance, 44% of advisors would use Dara-Rd, while 22%

chose KRd. The remaining advisors were split equally (11%) between RVd reinduction, ixazomib-Rd, and

Dara-Vd

12

FIRST-RELAPSE THERAPY QUOTES

“If they were on 2 drugs, we switch to the alternative. If they

were on 3 drugs, usually going to carfilzomib and a steroid.”

“ERd is good with me, from the ELOQUENT trial.”

“I usually use pomalidomide when I've determined that

Revlimid is no longer worth anything.”

13

“I've not done tandem transplants in my patients because in

California, they only pay for one, so you're not going to get a

second.”“I mean if that [isatuximab] was a faster infusion than Dara,

Dara may be kind of pushed backwards and we may just

adopt that.”

“When daratumumab was approved it was fourth-line, and

then it's moved to third and then second. Now it's in first-

line, and so it's like a race, like a marathon.”

“I would jump on the orals and the subcu’s faster than I

would on the IV therapies.”

“I'm more on-board with antibodies second-line for sure.

Dara combined with what was not used [in the first line].”

“[If] they relapse on Revlimid, I actually switch and just use

Kd as an IV infusion once a week. Because then I have

Pom to give them later with an antibody.”

SUBSEQUENT-RELAPSE THERAPY

Topic Data and Insights

Heavily pretreated

disease

• Only 44% of advisors were aware of the 6-month median PFS associated with double-refractory

disease; 33% answered 9 months

• Advisors were very aware and interested in venetoclax data, with 100% of them knowing about its

single-agent activity in myeloma

• For a now-77-year-old patient, previously treated with RVd induction and stem cell transplant, who is

currently relapsing for a second time after 1.5 years in VGPR on IRd, 78% of advisors would attempt

a triplet combination therapy, while the remaining would opt only for a doublet combination

– Dara-Pom-Dex was the regimen preferred by 63% of advisors, while 25% of advisors preferred

Car-Pom-Dex; the remaining chose standard dose of Car-Dex

• A few advisors have started using elotuzumab, venetoclax, and selinexor and generally see good

responses, although they are cautious with regard to the toxicities of selinexor, and are unsure of

what to expect, how to manage those comorbidities, or the dosage modifications

– Advisors are curious about using isatuximab, especially after daratumumab, since there is no

information on its efficacy post-daratumumab

– At least 2 advisors have used bendamustine and stated that it is very well tolerated

• Among novel therapies discussed, advisors are wary of using BCMA-drug conjugates due to the high

ocular toxicity and limited knowledge on its management

• Advisors are not completely adopting CAR T-cell therapies just yet, due to lack of knowledge and

expertise in that area, although there is some interest in the bispecific antibodies

• At least 1 advisor would consider clinical trials in place of selinexor in a penta-refractory setting

14

SUBSEQUENT-RELAPSE THERAPY QUOTES

[On using venetoclax off-label for myeloma] “We tried him on it,

and he had a miraculous response. Within a week or 10 days, this

guy was up and around from death's bed. The response lasted about

2 years. He is now relapsing again, but it was a phenomenal

response.”

[On use of monoclonal antibodies] “I've used more daratumumab

than elotuzumab. Isatuximab looks great [too]. My concern is that, the

more we use daratumumab upfront, especially if it makes it into the

first line and more second line, what's the benefit going to be for

those patients, basically?”

“I think having selinexor available is interesting. I would welcome the

opportunity to try it and see what kind of toxicities and how patients

tolerate it. I heard it's quite toxic.”

15

[On drug sequencing] “I think it's very hard. And for all the new

molecular inhibitors, and acceptance for venetoclax, we don't have

really kind of like a specific indication of which one we should use for

our patients.”

“We follow mSMART for the first 2 lines, and then it's m-clueless!”[On selinexor use] “From what I know, it's a reasonable thing. I think

as a single agent, it's probably not strong enough to really see the

price and side effects made worthwhile. So combining it with

something else would be compelling, and maybe at a dose that's a

little more [ie, a little higher dose].”

“A colleague has used selinexor as such we had our in-service, and

you talk about tying up a chair on a weekly basis for hydration and

antiemetics. It just ain't worth it.”

“In terms of the BCMA therapies, I think that the CAR T is going to

remain in our colleagues' hands who are going to have the most

experience with it in academic centers. I don't think it's going to

extrapolate to the community-based setting.”

STRATEGIC CONSIDERATIONS – DARATUMUMAB

> Daratumumab has so far been the treatment of choice in the R/R setting, and advisors utilize it in combination with several different drugs. Use of daratumumab in the frontline setting is still

relatively new for several advisors, but they are definitely interested in seeing more data on its

efficacy in the first line. However, advisors are more likely to use Dara in transplant-ineligible

patients in the first line

> Peer-to-peer knowledge exchange, education on evidence for daratumumab in MM, and additional communication opportunities should be considered

− Raise awareness regarding the ongoing GRIFFIN trial and the potential use of Dara-RVd as induction therapy for transplant-eligible patients, and simultaneously educate about the efficacy of daratumumab-

based regimens in the frontline setting in transplant-ineligible patients

− Continue to educate on the efficacy of daratumumab in combination with pomalidomide and bortezomib, in the R/R setting

− Use the data on PFS, OS, ORR, and higher rates of MRD negativity to sustain interest in daratumumab in light of other competing CD38 antibodies emerging in the market

16

Multiple Myeloma ARS

BASELINE

IN HOW MANY MM PATIENTS HAVE YOU EVER USED THE DRUG POMALYST/POMALIDOMIDE? (N = 9)

18

0%

11%

44%

22%

11% 11%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

0 1–3 4–7 8–10 11–15 >15

IN HOW MANY MM PATIENTS HAVE YOU EVER USED THE DRUG KYPROLIS/CARFILZOMIB? (N = 9)

19

0%

11%

33%

22% 22%

11%

0%

5%

10%

15%

20%

25%

30%

35%

0 1–3 4–7 8–10 11–15 >15

IN HOW MANY MM PATIENTS HAVE YOU EVER USED THE DRUG EMPLICITI/ELOTUZUMAB? (N = 9)

20

33%

44%

11% 11%

0% 0%0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

0 1–3 4–7 8–10 11–15 >15

IN HOW MANY MM PATIENTS HAVE YOU EVER USED THE DRUG NINLARO/IXAZOMIB? (N = 9)

21

0%

67%

22%

11%

0% 0%0%

10%

20%

30%

40%

50%

60%

70%

80%

0 1–3 4–7 8–10 11–15 >15

IN HOW MANY MM PATIENTS HAVE YOU EVER USED THE DRUG DARZALEX/DARATUMUMAB? (N = 9)

22

0%

22%

56%

22%

0% 0%0%

10%

20%

30%

40%

50%

60%

0 1–3 4–7 8–10 11–15 >15

IN HOW MANY MM PATIENTS HAVE YOU EVER USED THE DRUG FARYDAK/PANOBINOSTAT? (N = 9)

23

89%

11%0% 0% 0% 0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0 1–3 4–7 8–10 11–15 >15

Multiple Myeloma ARS

FIRST-LINE THERAPY

MY MOST COMMON INDUCTION REGIMEN FOR TRANSPLANT-ELIGIBLE PATIENTS IS (N = 9)

25

0% 0% 0%

89%

11%0% 0% 0% 0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Vd Rd Kd RVd KRd CyBorD (VCd) Ixazomib-Rd Daratumumab +VTd

Other

MY MOST COMMON INDUCTION REGIMEN FOR TRANSPLANT-INELIGIBLE PATIENTS IS (N = 9)

26

0%

11%

0%

67%

0% 0% 0% 0% 0%

22%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Vd Rd Kd RVd KRd CyBorD (VCd) Ixazomib-Rd Daratumumab+ VMP

Daratumumab+ Rd

Other

IS MELPHALAN STILL PART OF YOUR INDUCTION TREATMENT FOR OLDER PATIENTS? (N = 9)

27

11%

89%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Yes No

I BELIEVE THAT 3-DRUG COMBINATIONS ARE SUPERIOR TO 2-DRUG REGIMENS FOR YOUNGER PATIENTS (N = 9)

28

100%

0%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

True False

I BELIEVE THAT 4-DRUG COMBINATIONS ARE SUPERIOR TO 3-DRUG REGIMENS FOR YOUNGER PATIENTS (N = 9)

29

56%

44%

0%

10%

20%

30%

40%

50%

60%

True False

MAINTENANCE THERAPY SHOULD BE GIVEN TO ALL PATIENTS (N = 9)

30

100%

0%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

True False

A PATIENT WITH HIGH-RISK GENETICS AFTER AUTO-TRANSPLANT SHOULD RECEIVE: (N = 9)

31

56%

22%

11% 11%

0% 0% 0%0%

10%

20%

30%

40%

50%

60%

R maintenance Rd maintenance V or Vd maintenance RV maintenance RVd maintenance Other No maintenance

EARLY VS DELAYED TRANSPLANT DOES NOT IMPACT PFS (N = 9)

32

22%

78%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

True False

PATIENT CASE

> 68-year-old male presents with new-onset back pain. Workup demonstrates DJD on plain films. Labs show the presence of mild anemia (Hgb of 11.6), elevated total

protein (8.1), and normal albumin. B2M is 3.0. Creatinine is normal. Skeletal survey

is normal, and SPEP shows the presence of a 1.2 g/dL IgG kappa protein in the

blood, and 50 mg/24 hr of kappa light chain in the urine. Free light assay shows a

free kappa of 45 with a lambda of 12 (ratio 3.5:1)

> Bone marrow report states “15% plasma cells consistent with plasma cell myeloma” with normal cytogenetics and FISH that shows del13q

33

THE PATIENT HAS: (N = 9)

34

33%

11%

44%

11%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

ISS stage 1 myeloma ISS stage 2 myeloma Smoldering myeloma High-risk smoldering myeloma

PATIENT CASE (CONT.)

> The patient has a negative PET scan and is observed, as he has smoldering myeloma. Four years later he begins to develop progressive anemia (Hgb of 9.8),

and a repeat marrow shows 50% plasma cells

35

WHAT WOULD BE YOUR CHOICE OF INDUCTION THERAPY?

(N = 9)

36

0%

78%

0%

22%

0%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

VCd RVd Rd KRd Other

PATIENT CASE (CONT.): THE PATIENT IS TREATED WITH RVD INDUCTION THERAPY AND AFTER 4 CYCLES ACHIEVES A VGPR WITH IMPROVEMENT IN SYMPTOMS AND ANEMIA. AT THIS POINT YOU WOULD: (N = 9)

37

22%

67%

11%

0%0%

10%

20%

30%

40%

50%

60%

70%

80%

Refer for stem cell collection but delaytransplant

Refer for stem cell collection andproceed with transplant

Continue with full-dose RVd Stop RVd and switch to lenalidomidemaintenance

PATIENT CASE

> An 82-year-old retired teacher presents with fatigue and new-onset back pain at the T12 level. Imaging reveals compression fracture. She has mild anemia (Hgb

10.9 g/dL), normal renal function, and no hypercalcemia. Her TP is elevated (9

g/dL). A bone marrow shows 90% IgA lambda plasma cells. Serum free light chain

is 20 mg/dL. FISH is “normal.” Bone survey shows multiple lytic lesions

38

WHAT WOULD YOUR CHOICE OF INDUCTION THERAPY BE?

(N = 9)

39

44%

11% 11%

0%

11%

0% 0%

22%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

RVd Rd VCd Dara-VMP Dara-Rd KRd IRD Other

ARE YOU CURRENTLY ASSESSING FOR MRD IN YOUR CLINICAL PRACTICE? (N = 8)

40

13%

88%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Yes No

WHAT METHOD DO YOU TYPICALLY USE TO ASSESS MRD? (N = 9)

41

11% 11% 11%

67%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Flow cytometry PCR Next-generation sequencing I do not assess MRD

Multiple Myeloma ARS

FIRST-RELAPSE THERAPY

IN A PATIENT WHO HAD PROGRESSED AFTER TRANSPLANT, WHO IS NOT ON MAINTENANCE THERAPY, WHICH FACTOR IS MOST IMPORTANT TO YOU IN CHOOSING SALVAGE TREATMENT? (N = 9)

43

0% 0% 0%

100%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Cost Convenience Mechanism of action Prior treatment

THE KEY ADVANTAGE OF CARFILZOMIB RELATIVE TO OTHER CHOICES IS: (N = 9)

44

22%

67%

11%

0%0%

10%

20%

30%

40%

50%

60%

70%

80%

Dosing schedule CR rate OS advantage Safety profile

THE KEY DISADVANTAGE OF CARFILZOMIB RELATIVE TO OTHER CHOICES IS: (N = 9)

45

56%

22%

0%

22%

0%

10%

20%

30%

40%

50%

60%

IV administration Overall safety profile No OS advantage Frequency of clinic visits

THE KEY ADVANTAGE OF ELOTUZUMAB RELATIVE TO OTHER CHOICES IS: (N = 9)

46

0%

22%

44%

33%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Less-frequent dosing Safety profile Mechanism of action Synergy with lenalidomide

THE KEY DISADVANTAGE OF ELOTUZUMAB RELATIVE TO OTHER CHOICES IS: (N = 9)

47

11%

67%

11% 11%

0%

10%

20%

30%

40%

50%

60%

70%

80%

IV dosing frequency Lack of single-agent activity Lack of combination data Duration of PFS benefits

THE KEY ADVANTAGE OF IXAZOMIB RELATIVE TO OTHER CHOICES IS: (N = 9)

48

78%

0% 0%

22%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Oral agent Safety profile Combinability Activity in high-risk MM

THE KEY DISADVANTAGE OF IXAZOMIB RELATIVE TO OTHER CHOICES IS: (N = 8)

49

25%

0%

38% 38%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Limited single-agent data Safety profile Difficulty in obtaining reimbursement Similar MOA to bortezomib

THE KEY ADVANTAGE OF DARATUMUMAB RELATIVE TO OTHER CHOICES IS: (N = 9)

50

44%

11%

44%

0%0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Novel MOA Safety profile Efficacy Combinability

THE KEY DISADVANTAGE OF DARATUMUMAB RELATIVE TO OTHER CHOICES IS: (N = 9)

51

56%

44%

0% 0%0%

10%

20%

30%

40%

50%

60%

Infusion reactions Schedule of administration Blood bank issues Interference with SPEP/IFE

PATIENT CASE (CONT.)

> The prior 68-year-old male with smoldering myeloma that transformed to IgG kappa myeloma, who was treated with RVd and in VGPR, elects to collect stem

cells and proceed with immediate transplant. After transplant, the patient is in CR

and declines maintenance therapy

> After 4 years the patient begins to develop new back pain and anemia. Bone marrow shows the presence of 40% plasma cells, no change in cytogenetics, and

10% of the cells show the presence of del17p

52

WHICH OPTION WOULD YOU USE AS SALVAGE THERAPY? (N = 9)

53

11% 11%

22%

0% 0% 0% 0%

44%

11%

0%0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Multiple Myeloma ARS

SUBSEQUENT-RELAPSE THERAPY

MEDIAN PFS FOR DOUBLE-REFRACTORY (LENALIDOMIDE AND BORTEZOMIB REFRACTORY) MULTIPLE MYELOMA IS:(N = 9)

55

22%

44%

33%

0%0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

3 months 6 months 9 months 12 months

VENETOCLAX HAS NO SINGLE-AGENT ACTIVITY IN MULTIPLE MYELOMA (N = 9)

56

0%

100%

0%

20%

40%

60%

80%

100%

120%

True False

PATIENT CASE (CONT.)

> The patient chooses to receive IRD, due to travel in his retirement. After 4 cycles he is back in VGPR and tolerating treatment well

> He stays on triplet therapy for 1.5 years and does not require dose reductions other than reduced-dose Dex. However, he then begins to exhibit progressive

anemia. Repeat marrow shows 50% plasma cells that are found to carry del17p

on FISH

57

AT THIS TIME, WOULD YOU CONSIDER TRIPLET COMBINATION THERAPY, A DOUBLET, OR A SINGLE AGENT (IE, DARATUMUMAB)? (N = 9)

58

78%

22%

0%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Triplet Doublet Single agent

WHICH OF THE FOLLOWING WOULD YOU CONSIDER ON THE BASIS OF YOUR ANSWER ABOVE? (N = 8)

59

13%0%

63%

25%

0% 0% 7% 0%0%

10%

20%

30%

40%

50%

60%

70%

Advisor Takeaways

ADVISOR KEY TAKEAWAYS (1/2)

61

Dr 1

• Daratumumab in first-line is intriguing. But will wait for more

data with RVd backbone

• Transplant remains standard of care, although the benefit in

question if we adopt quad upfront therapy

• Venetoclax single agent with t(11:14)

Dr 2

• Optimal use of Dara – Data?

• Options of 1st line: VRd, KRd

• Relapsed: Many choices; Venetoclax t(11:14)

Dr 3

• Induction – 3 vs 4 drugs

• Upfront Dara?

• Role of Elotuzumab vs other options

Dr 4

• 4 drugs better than 3

• Elo probably still good after Dara

• Venetoclax t(11:14). BCMA ables

Dr 5

• Adding CD38 inhibitor to 3-drug combo showed superior

MRD-rate and OR

• Multiple options for 2nd line treatment: how to choose the

most appropriate one still a challenging question

• For the new small molecule inhibitors, we are waiting (for)

more data to show the specific indications for each of those

inhibitors

Dr 6

• Learned (through multiple clinical trials presented) of the

plethora of combination therapies for 1st line therapy and the

advantages and disadvantages of each. Also Zometa

duration

• Roundtable discussion on side-effects/AEs of new drugs and

how to triage them

• Developing a personalized approach to relapsed disease

with the combination therapies

ADVISOR KEY TAKEAWAYS (2/2)

62

Dr 7

• 4 drug > 3 drug induction

• Ixazomib/Rev/Dex oral induction

• Dara-Rd frail/transplant ineligible/neuropathic

Dr 8

• Reinforced my biases

• Transplant still worthwhile

• Costs are through the roof

Dr 9

• Consider weekly carfilzomib at lower dose

• Await Griffin study – 1st line Dara/Rev

• I don’t want BCMA Ig

• Learned about use of Venetoclax in pts with t(11:14)